番茄社区

Nearly all Americans live within an hour of emergency care for acute stroke, even if only by telestroke services, a study found.

Fully 96% of the U.S. population had access to an emergency department with any acute stroke capabilities within 60 minutes, reported Kori S. Zachrison, MD, MSc, of Massachusetts General Hospital in Boston, during the American Stroke Association's International Stroke Conference, held virtually and in person in New Orleans.

That represents an advance from 2011, when nearly 20% of the population didn't have timely access to a center where they could get thrombolytics, Zachrison and colleagues noted in a paper simultaneously published in .

"This increase likely reflects the extensive and ongoing work to improve stroke systems of care, including greater stroke center accreditation and expansion of telestroke capacity," they wrote.

While a major advancement, the findings suggest that the infrastructure part of advancing rapid stroke treatment might have just about peaked, said Cheryl Bushnell, MD, of the Comprehensive Stroke Center at Wake Forest Baptist Health in Winston-Salem, North Carolina, who is a spokesperson for the American Stroke Association.

However, "I think we might be struggling and maybe even going backward in having enough stroke experts for either the televideo or telestroke consults or working in the emergency department in person," she noted in an interview with 番茄社区 monitored by her institution's media relations. "Having the processes in place is great, having the people is the challenge right now."

Other things that are outside of the hospitals' control, like getting people to immediately recognize stroke and seek medical care, and how long it actually takes for transport to the emergency department, are still a problem as well, she added.

Still, the analysis by Zachrison and colleagues turned up more than 13 million people (4% of the total U.S. population) who even in the best of circumstances wouldn't be able to reach emergency services with any acute stroke capability and some 5 million without 60-minute access to any emergency department at all.

"Although the smaller, critical access hospitals serving patients in rural areas are the most likely to benefit from telestroke services, they are currently the least likely to have them," Zachrison's group noted. "Addressing this care gap and other disparities in access will be critical to improving equitable access to acute stroke care for all Americans."

Another recent study documented for stroke care that particularly affect rural communities with a high proportion of minority residents.

The current study collated data from the 2019 National Emergency Department Inventory to identify all open emergency departments, which self-reported telestroke capacity and whether each was part of a hospital stroke center (including hospitals that can provide acute care even if patients require subsequent transfer). Calculation of timely access used 2020 U.S. Census data, looking for prehospital transport time of 60 minutes or less based on 2019 National Emergency Medical Services Information System data, considering EMS dispatch, response, scene times, and driving times.

Of the 5,587 emergency departments open in 2019, 46% were part of stroke centers and 45% had telestroke services. Of the 3,024 emergency departments not in a stroke center, 36% said they had telestroke capacity.

A comprehensive or thrombectomy-capable stroke center was within 60 minutes for 64% of the U.S. population.

Not surprisingly, the highest access to timely stroke care overall was in the mid-Atlantic region, with 99% of its population within 60 minutes of a telestroke-capable emergency department or a stroke center, and lowest in the Mountain West, at 91%.

A limitation to the study was the self-reporting of telestroke capabilities, which Zachrison's group did not confirm.

Comment